Natural combination hormone replacement formulations and therapies

ABSTRACT

Estrogen and progesterone replacement therapies are provided herein. Among others, the following formulations are provided herein: solubilized estradiol without progesterone; micronized progesterone without estradiol; micronized progesterone with partially solubilized progesterone; solubilized estradiol with micronized progesterone; solubilized estradiol with micronized progesterone in combination with partially solubilized progesterone; and solubilized estradiol with solubilized progesterone.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to the following U.S. patentapplications: U.S. application Ser. No. 13/684,002, entitled “NATURALCOMBINATION HORMONE REPLACEMENT THERAPIES,” which was filed on Nov. 21,2012; U.S. Provisional Application Ser. No. 61/661,302, entitled“ESTRADIOL FORMULATIONS,” which was filed on Jun. 18, 2012; and U.S.Provisional Application Ser. No. 61/662,265, entitled “PROGESTERONEFORMULATIONS,” which was filed on Jun. 20, 2012. All aforementionedapplications are hereby incorporated by reference herein in theirentirety.

BACKGROUND

1. Field

This disclosure relates to natural estrogen and progesterone replacementtherapies, with formulations provided for each estradiol andprogesterone alone and in combination for the treatment of pre,peri-menopausal, menopausal and post-menopausal females in relation tothe treatment of Estrogen- and Progesterone-deficient States, each asherein below defined.

2. Discussion of the Related Art

Hormone replacement therapy (HRT) is a medical treatment that involvesthe use of one or more of a group of medications designed to increasehormone levels in women who lack adequate hormone production. HRT canmitigate and prevent symptoms caused by diminished circulating estrogenand progesterone hormones regardless as to whether the subject ispre-menopausal, peri-menopausal, menopausal or post-menopausal. However,specific disease states can exist during each stage of menopausalprogression.

HRT is presently available in various forms. One therapy involvesadministration of low dosages of one or more estrogens. Another involvesadministration of progesterone or a chemical analogue, called aprogestin. Progesterone administration acts, among treating otherdisease states, to mitigate certain undesirable side effects fromestrogen administration including, for example, endometrial hyperplasia(thickening), reducing the incidence of endometrial cancer.

Timing for dosage administration is often varied cyclically, withestrogens taken daily and progesterone taken for approximately two weeksof every month; a method often referred to as “Cyclic-Sequential” or“Sequentially-Combined HRT.” This method is intended to mimic thenatural menstrual cycle and typically causes menstruation similar to aperiod after the progesterone is stopped. This regimen is most typicallyused in peri-menopausal or newly menopausal women as the alternativecontinuous method often results in irregular bleeding in such women. Analternate method, a constant dosage with both estrogen and progesteronetaken daily, is called “continuous-combined HRT.” This method usuallyresults in no menstruation and is used most often after a woman has beenmenopausal for some time.

Estrogen, in its various forms, and progesterone, in its various forms,are used in HRT via a variety of administered dosage forms including,for example, via tablets, capsules and patches.

“Bio-identical” hormones, which are identical in chemical structure tothe hormones naturally produced by human bodies can be used and areoften referred to as natural hormone replacement therapy, or NHRT.

These natural or bio-identical hormones are formulated from variousingredients to match the chemical structure and effect of estradiol,estrone, or estriol (the 3 primary estrogens) as well as progesteronethat occur naturally in the human body (endogenous).

Currently, bio-identical estradiol is available in both branded andgeneric FDA approved versions. FDA-approved bio-identical progesteronefor HRT is available as the branded stand-alone drug commerciallyidentified as Prometrium® (Abbott Laboratories, Abbott Park, Ill.), witha generic authorized by the innovator, and generic products provided byTeva (Israel) and Sofgen Americas, Inc (New York). Prometrium wasapproved for sale in the United States on May 14, 1998 under NDA#N019781. According to the prescribing information approved for thisproduct (Rev June 2009) (“Prometrium prescribing information”),Prometrium comprises synthetic progesterone that is chemically identicalto progesterone of human ovarian origin. Capsules comprise 100 mg or 200mg of micronized progesterone. The inactive ingredients include peanutoil, gelatin, glycerin, lecithin, titanium dioxide, and yellow and reddyes.

Other products such as Prempro® and Premphase® (Wyeth Laboratories, adivision Pfizer, Inc., New York) provide both continuous-combined andcyclic-sequential products containing Premarin (estrogen derived frommare's urine) and synthetic medroxyprogesterone acetate. Other productsare available. However, no FDA approved product exists on the markettoday with combination bio-identical estradiol and bio-identicalprogesterone.

SUMMARY

According to various embodiments of the disclosure, natural hormonereplacement therapies are provided comprising cyclic/sequential andcontinuous-combined delivery via pharmaceutical formulations ofsolubilized estradiol and micronized and/or partially or completelysolubilized progesterone. Estradiol and micronized and/or partially orcompletely solubilized progesterone delivered together daily can becombined in either a single unit dose or in separate unit doses,typically in a soft capsule. A 28-day or monthly regimen of tablets orcapsules can be packaged in a single blister pack having delivery daysidentified to improve compliance. Various examples formulations ofnatural hormones, and the use of these formulations for hormonereplacement therapies, each in accordance with the invention are setforth below.

BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES

The accompanying drawings, which are incorporated herein and form a partof the specification, illustrate the present disclosure and, togetherwith the description, further serve to explain the principles of thedisclosure and to enable a person skilled in the pertinent art to makeand use the disclosed embodiments.

FIG. 1 illustrates an exemplary manufacturing process of a fill materialin accordance with various embodiments;

FIG. 2 illustrates an exemplary manufacturing process of a softgelmaterial in accordance with various embodiments;

FIG. 3 illustrates an exemplary manufacturing process in accordance withvarious embodiments; and

FIG. 4 illustrates a graph of the particle distribution obtained inExample 10.

FIG. 5 illustrates a dissolution study of a formulation in accordancewith various embodiments of the invention.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

Frequently, higher recommended oral dosages of pharmaceuticals arenecessary to treat a given disease state because many active ingredientsare not completely absorbed by a patient in need of treatment. In otherwords, a better-absorbed dosage form of a medicament such as, forexample, progesterone, or dosage forms that provide greater consistencyof absorption of progesterone among subjects, alone or in combinationwith estradiol, may be able to be administered at dosage strengths lowerthan presently recommended, potentially resulting in a reduced orminimized side effect profile, among other potential benefits.

DEFINITIONS

The term “micronized progesterone,” as used herein, includes micronizedprogesterone having an X50 particle size value below about 15 micronsand/or having an X90 particle size value below about 25 microns.

The term “X50,” as used herein, means that one-half of the particles ina sample are smaller in diameter than a given number. For example,micronized progesterone having an X50 of 5 microns means that, for agiven sample of micronized progesterone, one-half of the particles havea diameter of less than 5 microns. Similarly, the term “X90” means thatninety percent (90%) of the particles in a sample are smaller indiameter than a given number.

The term “medium chain,” as used herein means any medium chaincarbon-containing substance, including C4-C18, and including C6-C12substances, fatty acid esters of glycerol, fatty acids, and mono-, di-,and tri-glycerides of such substances.

The term “uniform distribution” means at least one of uniformdispersion, solubility, or lack of agglomeration of progesterone in adissolution test compared to Prometrium at a similar dosage strength andthe same USP dissolution apparatus.

The term “bioavailability,” as used herein means the concentration of anactive ingredient (e.g., progesterone or estradiol or estrone) in theblood (serum or plasma). The relative bioavailability may be measured asthe concentration in the blood (serum or plasma) versus time. Otherpharmacokinetic (pK) indicators may be used to measure and assessbioavailability, determined by suitable metrics including AUC, Cmax, andoptionally, Tmax.

The term “AUC,” as used herein, refers to the area under the curve thatrepresents changes in blood concentration of progesterone, estradiol orestrone over time.

The term, “Cmax” as used herein, refers to the maximum value of bloodconcentration shown on the curve that represents changes in bloodconcentrations of progesterone, estradiol or estrone over time.

The term, “Tmax” as used herein, refers to the time that it takes forprogesterone, estradiol or estrone blood concentration to reach themaximum value.

Collectively AUC, Cmax and, optionally, Tmax are the principlepharmacokinetic parameters that can characterize the pharmacokineticresponses of a particular drug product such as progesterone in an animalespecially a mammal, including human, subject.

The term “solubilizer,” as used herein, means any substance or mixtureof substances that may be used to enhance the solubility of estradiol,including, for example and without limitation, appropriatepharmaceutically acceptable excipients, such as solvents, co-solvents,surfactants, emulsifiers, oils and carriers.

The term “excipients,” as used herein, refer to non-activepharmaceutical ingredients (“API”) substances such as carriers,solvents, oils, lubricants and others used in formulating pharmaceuticalproducts. They are generally safe for administering to animals,especially mammals, including humans, according to establishedgovernmental standards, including those promulgated by the United StatesFood and Drug Administration.

The term “oil” as used herein may be any pharmaceutically acceptablesubstance, such as an organic oil other than peanut oil, that wouldsuspend and/or solubilize any suitable progesterone, starting material,or precursor, including micronized progesterone as described herein.More specifically, oils may include, for example and without limitation,medium chain fatty acids, generally of the group known as medium chainfatty acids consisting of at least one mono-, di-, and triglyceride, orderivatives thereof, or combinations thereof.

“Fully solubilized progesterone” as used herein means progesterone whichis about 100% in solution, i.e., at least 98% in solution.

“Partially solubilized progesterone” as used herein means progesteronewhich is in any state of solubilization up to but not including about100%, i.e., up to but not including 98% in solution.

As used herein, unless specified, estradiol includes estradiol inanhydrous and hemihydrate forms.

DESCRIPTION

Provided herein are the following formulations: solubilized estradiolwithout progesterone; micronized progesterone without estradiol;micronized progesterone with partially solubilized progesterone;solubilized estradiol with micronized progesterone; solubilizedestradiol with micronized progesterone in combination with partiallysolubilized progesterone; and solubilized estradiol with solubilizedprogesterone. The underlying formulation concepts provided herein may beused with other natural or synthetic forms of estradiol andprogesterone. Micronization specifications, aspects and embodiments arefurther defined herein.

Generally, the pharmaceutical formulations described herein are preparedand administered as filled capsules, typically soft capsules of one ormore materials well known in the art including, for example and withoutlimitation, soft gelatin capsules. Micronized progesterone, as describedherein, may also be prepared for administration in tablets or otherwell-known orally administered dosage forms using standard techniques.

Another aspect of the present disclosure includes a pharmaceuticalformulation of micronized progesterone, micronized progesterone withpartially solubilized progesterone and fully solubilized progesterone,wherein said formulation may provide increased progesteronebioavailability in a treated subject compared to the bioavailabilityprovided by Prometrium® when administered at equal dosage strengths.

In accordance with various aspects and embodiments, the solubilityproportion (i.e., the proportion of a solute that enters solution) isnotable. The weight ratio of estradiol to the weight of the entiresolution is also notable due to the intended dose amounts, discussedherein. In particular, it is desirable to obtain a target dosage ofestradiol in an amount of solution that may be readily administered viaa capsule. For example, if it is desired to have a dose of estradiol ina capsule of between about 0.125 mg to about 2 mg, it would also bedesirable to have a total solution weight to be between about 250 mg toabout 400 mg, preferably about 300 mg to about 350 mg and morepreferably about 325 mg. In various embodiments, the following weightratios of estradiol to total solution is from about 0.125/50 mg to about0.125/1000 mg, from about 1 mg:500 mg to about 1 mg:50 mg; from about 1mg:250 mg to about 1 mg:60 mg; from about 1 mg:100 mg to about 1 mg:66mg; from about 2 mg/50 mg to about 2 mg/1000 mg. In various embodiments,the target for single dose product is 325 mg, and a target fill weightfor a combination product (e.g., two or more sterol APIs) is 650 mg.

In illustrative embodiments, total progesterone, i.e., dissolved andmicronized, is 20 to 50 wt %, e.g., 30 to 35 wt %; estradiol is 0.1 to0.8 wt %, e.g., 0.15 to 0.35 wt %.

Other aspects of the present disclosure further provide: more uniformdissolution of progesterone, and reduced intra- and inter-patient bloodlevel variability in formulations of progesterone of the presentdisclosure, typically in combinations with solubilized estradiol, whencompared to equal dosages of Prometrium. Blood level variability is alsocompared at equal sampling times following administration. Not to belimited by theory, these aspects are believed to be influenced by thepercentage of solubilized progesterone in a respective formulationwherein such more uniform dissolution of progesterone, and lower intra-and inter-patient blood level variability, are influenced by a greaterproportion of solubilized progesterone relative to total progesterone. Areduced food effect with the present formulations comprisingprogesterone may also be implicated.

According to the Prometrium prescribing information, clinical trialshave shown significant patient variability. For example, a clinicaltrial involving postmenopausal women who were administered Prometriumonce a day for five days resulted in the mean PK parameters listed inthe following table:

Prometrium Capsules Daily Dose Parameter 100 mg 200 mg 300 mg C_(max)17.3 +/− 21.9 38.1 +/− 37.8 60.6 +/− 72.5 (ng/ml) T_(max) 1.5 +/− 0.82.3 +/− 1.4 1.7 +/− 0.6 (hr) AUC₀₋₁₀ 43.4 +/− 30.8 101.2 +/− 66.0  175.7+/− 170.3 (ng × hr/ml)

In a particular illustrative aspects and embodiments of this invention,it is possible, though not necessary, to reduce the standard deviationsin one or more of these PK parameters.

More uniform dissolution of progesterone in a formulation of the presentdisclosure compared to the dissolution of Prometrium at equal dosagestrengths and using the same USP apparatus can be determined usingstandard techniques established for API dissolution testing, includingthat which is described in the examples below.

Reduced intra- and inter-patient variability of progesterone formulatedpursuant to the present disclosure compared to Prometrium can bedemonstrated via a fed bio-study such as that described below.

Other aspects of the present disclosure includes the use of formulationsas described herein wherein progesterone is at least one API in saidformulation for the treatment of an animal, especially a mammal,including humans: for endometrial hyperplasia; for secondary amenorrhea;as a method of treatment for preterm birth, when said animal has ashortened cervix, and other disease states or conditions treated withsupplemental progesterone (collectively, “Progesterone-deficientStates”); and the use of formulations as described herein whereinestradiol is at least one API in said formulation for the treatment ofan animal, especially a mammal, including humans, havingmenopause-related symptoms including, for example, vasomotor symptoms;in relation to treatment of hypoestrogenism related symptoms including,for example and without limitation, hot flashes and night sweats(vasomotor symptoms), sleep disturbances, mood changes and vulvo-vaginalatrophy; and osteoporosis and other non-menopausal disease states orconditions treated with supplemental estrogen. (collectively,“Estrogen-deficient States”), each in a subject in need of treatment,and each with a non-toxic effective amount of said formulations. As usedherein, the term “treatment”, or a derivative thereof, contemplatespartial or complete inhibition of the stated disease state when aformulation as described herein is administered prophylactically orfollowing the onset of the disease state for which such formulation isadministered. For the purposes of the present disclosure, “prophylaxis”refers to administration of the active ingredient(s) to an animalespecially a mammal, to protect the animal from any of the disorders setforth herein, as well as others.

Unless otherwise specified, “natural,” as used herein with reference tohormones discussed herein, means bio-identical hormones formulated tomatch the chemical structure and effect of those that occur naturally inthe human body (endogenous). An exemplary natural estrogen is estradiol(also described as 17β-estradiol and E2) and a natural progestin isprogesterone. An exemplary cyclic/sequential regimen comprises deliveryof from about 0.125 mg to about 2.0 mg of estradiol daily for 14-18days, followed by delivery of from about 0.125 mg to about 2 mg ofestradiol and about 25 mg to about 200 mg of progesterone daily for10-14 days. Cyclic/sequential regimens may be especially useful formenopausal females. Other exemplary dosage strengths for estradiol foruse in the formulations described herein include, without limitation,0.125, 0.25, 0.375, 0.50, 0.625, 0.75, 1.00, 1.125, 1.25, 1.375, 1.50,1.625, 1.75 and 2.00 mg. Other exemplary dosage strengths forprogesterone for use in the formulations described herein include,without limitation, 25, 50, 75, 100, 125, 150, 175, 200 mg, 250 mg, 300mg, 350 mg and 400 mg. These dosage strengths for each of estradiol andprogesterone can be administered in formulations described herein eitheralone or in combination.

Progesterone active pharmaceutical ingredient may be micronized via anyone of the multiple methods typically utilized by the ordinarily skilledartisan. In various embodiments, micronized progesterone has an X50particle size value of less than about 15 microns, less than about 10microns, less than about 5 microns and/or less than about 3 microns. Invarious embodiments, micronized progesterone has an X90 particle sizevalue of less than about 25 microns, less than about 20 microns, and/orless than about 15 microns.

Particle size may be determined in any suitable manner. For example, aBeckman Coulter LS 13 320 Laser Diffraction Particle Size Analyzer (the“Beckman Device”) may be used to determine particle size. As describedabove, particle size may be represented by various metrics, for example,through an X50 particle size, and/or X90 particle size, or similardescriptions of particle size.

The Beckman Device may be used with various modules for introducing asample for analysis. The Beckman Device may be used with the LS 13 320Universal Liquid Module (“ULM”). The ULM is capable of suspendingsamples in the size range of 0.017 μm to 2000 μm. The ULM is a liquidbased module that allows for delivery of the sample to the sensing zone.The ULM recirculates the sample through the Beckman Device. The ULMcomprises two hoses, one for fluid delivery and another for waste. Thetotal volume used may be 125 mL or less. A sample mass of from about 1mg to about 10 g may be used. The ULM may interact with the BeckmanDevice via pins that fit into slots on the ULM. The ULM may use avariety of suspension fluids, for example, water, butonol, ethanol,chloroform, heptanes, toluene, propanol, COULTER Type 1B Dispersant(“Coulter 1B”), and a variety of other suspension fluids. Surfactantsmay also be used, though pump speed should be adjusted to preventexcessive bubbling. Coulter 1B may comprise one or more of acetaldehyde,ethylene oxide, and/or 1,4-dioxane. The Beckman Device may be configuredto use a variety of optical theories, including the Fraunhofer opticalmodel and the Mie Theory.

The Beckman Device may comprise software to control the Beckman Devicewhile the ULM is in use. The software may control, for example, pumpspeed, use of de-bubble routine, rinse routine, sonicate routine, andfill routine, among others. Parameters regarding the sample run may alsobe configured. For example, run length may be set. Though any suitablerun length may be used, in various embodiments, a time period of 30seconds to 120 seconds, and preferably between 30 seconds and 90 secondsmay be used.

The Beckman Device may be used with the LS 13 320 Micro Liquid Module(“MLM”). The MLM is capable of suspending samples in the size range of0.4 μm to 2000 μm. The MLM is a liquid based module that allows fordelivery of the sample to the sensing zone. The MLM includes a stirrer.The total volume used may be 12 mL or less. The MLM may use a variety ofsuspension fluids, both aqueous and non-aqueous.

Each of estradiol and progesterone as described herein can be formulatedalone pursuant to the teachings below. These formulations can beprepared for oral administration or can be combined, based oncompatibility, for co-administration of estradiol and progesterone in asingle oral unit dosage form.

Progesterone formulations of the present disclosure are prepared viablending with a pharmaceutically acceptable oil; generally, the oilcomprises at least one medium chain fatty acid such as medium chainfatty acids consisting of at least one mono-, di-, or triglyceride, orderivatives thereof, or combinations thereof. Optionally added are otherexcipients including, for example and without limitation, anti-oxidants,lubricants and the like. Sufficient oil is used to form a suspension ofmicronized progesterone or, in the alternative, solubilize progesterone.

Pharmaceutically acceptable oils include, without limitation, the use ofat least one of caproic fatty acid; caprylic fatty acid; capric fattyacid; tauric acid; myristic acid; linoleic acid; succinic acid;glycerin; mono-, di-, or triglycerides and combinations and derivativesthereof; a polyethylene glycol; a polyethylene glycol glyceride(Gelucire®; GATTEFOSSE SAS, Saint-Priest, France); a propylene glycol; acaprylic/capric triglyceride (Miglyol®; SASOL Germany GMBH, Hamburg;Miglyol includes Miglyol 810, 812, 816 and 829); acaproic/caprylic/capric/lauric triglyceride; a caprylic/capric/linoleictriglyceride; a caprylic/capric/succinic triglyceride; propylene glycolmonocaprylate; propylene glycol monocaprate; (Capmul® PG-8 and 10; theCapmul brands are owned by ABITEC, Columbus Ohio); propylene glycoldicaprylate; propylene glycol dicaprylate; medium chain mono- anddi-glycerides (Capmul MCM); a diethylene glycol mono ester (including2-(2-Ethoxyethoxy)ethanol: Transcutol); diethylene glycol monoethylether; esters of saturated coconut and palm kernel oil and derivativesthereof; triglycerides of fractionated vegetable fatty acids, andcombinations and derivatives thereof.

In other aspects and embodiments, progesterone is fully solubilizedusing, for example and without limitation, sufficient amounts of:Transcutol and Miglyol; Transcutol, Miglyol and Capmul PG 8 and/or PG10; Capmul MCM; Capmul MCM and a non-ionic surfactant; and Capmul MCMand Gelucire.

Various ratios of these oils can be used for full solubilization ofprogesterone. Capmul MCM and a non-ionic surfactant, e.g., Gelucire44/14, can be used at ratios of about 99:1 to 2:1, including, forexample and without limitation: 60:40, 65:35, 70:30, 75:25, 80:10,80:15, 85:20, 90:10, and 98:1. The ratios of oil (e.g., medium chainfatty acid esters of monoglycerides and diglycerides) to non-ionicsurfactant can be significantly higher. For example, in certainexamples, below, Capmul MCM and Gelucire were used in ratios of up toabout 65:1, e.g., 8:1, 22:1, 49:1, 65:1 and 66:1. See, e.g., Tables13-17, below. Thus, useful ratios can be 8:1 or greater, e.g., 60 to70:1. Among other combinations, these oils and/or solubilizers, asdefined herein, and combinations thereof, can be used to formcombination estradiol and progesterone formulations of the presentdisclosure.

Combinations of these oils can produce partially solubilizedprogesterone, depending upon the desired unit dosage amount ofprogesterone. The greater the amount of progesterone per unit dosageform, the less progesterone may be solubilized. The upward limit ofdosage strength per unit dose it generally limited only by the practicalsize of the final dosage form.

In illustrative embodiments of the invention, oils used to solubilizeestradiol and to suspend, partially solubilize, or fully solubilizeprogesterone include medium chain fatty acid esters, (e.g., esters ofglycerol, polyethylene glycol, or propylene glycol) and mixturesthereof. In illustrative embodiments, the medium chain fatty acids areC6 to C14 or C6 to C12 fatty acids. In illustrative embodiments, themedium chain fatty acids ore saturated, or predominantly saturated,e.g., greater than about 60% or greater than about 75% saturated. Inillustrative embodiments, estradiol or progesterone (or both) is solublein the oils at room temperature, although it may be desirable to warmthe oils up until they are in a liquid state. In illustrativeembodiments, the oil or oil/surfactant is liquid at between roomtemperature and about 50 C, e.g., at or below 50 C, at or below 40 C, orat or below 50 C. In illustrative embodiments, Gelucire 44/14 is heatedto about 65 C and Capmul MCM is heated to about 40 C to facilitatemixing of the oil and non-surfactant, although such heating is notnecessary to dissolve the estradiol or progesterone. In illustrativeembodiments, the solubility of estradiol in the oil (or oil/surfactant)is at least about 0.5 wt %, e.g., 0.8 wt % or higher, or 1.0 wt % orhigher.

Illustrative examples of mono- and diglycerides of medium chain fattyacids include, among others, Capmul MCM, Capmul MCM C10, Capmul MCM C8,and Capmul MCM C8 EP. These oils are C8 and C10 fatty acid mono- anddiglycerides. Illustrative examples of oils that are triglycerides ofmedium chain fatty acids include, among others, Miglyol 810 and Miglyol812.

Illustrative examples of oils that are medium chain fatty acid esters ofpropylene glycol include, among others, Capmul PG-8, Capmul PG-2L EP/NF,Capmul PG-8 NF, Capmul PG-12 EP/NF and Capryol. Other illustrativeexamples include Miglyol 840.

Illustrative examples of oils that are medium chain fatty acid esters ofpolyethylene glycol include, among others, Gelucire 44/14 (PEG-32glyceryl laurate EP), which is polyethylene glycol glycerides composedof mono-, di- and triglycerides and mono- and diesters of polyethyleneglycol. Without intending to be bound to any particular mechanism, itappears that at least in formulations comprising small amounts ofGelucire, e.g., 10 wt % or less, the primary function of this oil is asa non-ionic surfactant.

These illustrative examples comprise predominantly medium chain length,saturated, fatty acids, specifically predominantly C8 to C12 saturatedfatty acids. Specifically, a product information sheet for Myglyol bySASOL provides as the composition of fatty acids as follows:

Tests 810 812 818 829 840 Caproic acid max. 2.0 max. 2.0 max. 2 max. 2max. 2 (C6:0) Caprylic acid 65.0-80.0 50.0-65.0 45-65 45-55 65-80 (C8:0)Capric acid 20.0-35.0 30.0-45.0 30-45 30-40 20-35 (C10:0) Lauric acidmax. 2 max. 2 max. 3 max. 3 max. 2 (C12:0) Myristic acid max. 1.0 max.1.0 max. 1 max. 1 max. 1 (C14:0) Linoleic acid — — 2-5 — — (C18:2)Succinic acid — — — 15-20 —

It will be understood that oils are often mixtures. So, for example,when an oil is described herein as a saturated C8 fatty acid mono- ordiester of glycerol, it will be understood that the predominantcomponent of the oil, i.e., >50 wt % (e.g., >75 wt %, >85 wt % or >90 wt%) are caprylic monoglycerides and caprylic diglycerides. For example,the Technical Data Sheet by ABITEC for Capmul MCM C8 describes CapmulMCM C8 as being composed of mono and diglycerides of medium chain fattyacids (mainly caprylic) and describes the alkyl content as <=1%C6, >=95% C8, <=5% C10, and <=1.5% C12 and higher,

Mixtures of medium chain fatty acid glycerides, e.g., C6-C12, C8-C12, orC8-C10 fatty acid mono- and diglycerides or mono-, di-, andtriglycerides are very well suited for dissolving estradiol; goodresults have been obtained with an oil that is predominantly a mixtureof C8-C10 saturated fatty acid mono- and diglycerides. Longer chainglycerides appear to be not as well suited for dissolution of estradiol.On the other hand, high solubility of progesterone has been obtained inmixtures that are predominantly medium chain fatty acid triglycerides.

High solubility of estradiol has been obtained in2-(2-Ethoxyethoxy)ethanol, e.g., Transcutol and in Propylene glycolmonocaprylate, e.g., Capryol™ 90 (Gattefosse).

In illustrative embodiments of the invention, the selected oil does notrequire excessive heating in order to solubilize progesterone orestradiol. For example, when the formulation comprises medium chainfatty acid mono- and diglycerides (e.g., Capmul MCM) and polyethyleneglycol glycerides (e.g., Gelucire) as a surfactant, the oil and/or thesurfactant can be warmed up, e.g., to about 65 C in the case of thesurfactant and less in the case of the oil, to facilitate mixing of theoil and surfactant. The estradiol can be added at this temperature or atlower temperatures as the mixture cools or even after it has cooled astemperatures above room temperature, e.g., about 20 C, are not requiredto solubilize the estradiol in preferred oils. The progesterone can alsobe added as the mixture cools, e.g., to below about 40 C or to belowabout 30 C, even down to room temperature.

In various embodiments, estradiol is solubilized. Solubilized estradiolmay include estradiol that is approximately: 90% soluble in a solvent;93% soluble in a solvent; 95% soluble in a solvent; 97% soluble in asolvent; 99% soluble in a solvent; and 100% soluble in a solvent.Solubility may be expressed as a mass fraction (% w/w, also referred toas wt %).

In various embodiments, the solubilizing agent is selected from at leastone of a solvent or co-solvent. Suitable solvents and co-solventsinclude any mono-, di- or triglyceride and glycols, and combinationsthereof.

In addition to the oils referenced above for progesterone, which canalso be used as solubilizers for estradiol, other solubilizers include,for example and without limitation, glyceryl mono- and di-caprylates,propylene glycol and 1,2,3-propanetriol (glycerol, glycerin, glycerine).

Anionic and/or non-ionic surfactants can be used in other embodiments ofthe presently disclosed formulations containing estradiol, progesteroneor a combination thereof. In certain embodiments, a non-ionic surfactantis used. Exemplary non-ionic surfactants may include, for example andwithout limitation, one or more of oleic acid, linoleic acid, palmiticacid, and stearic acid esters or alcohols. In further embodiments, thenon-ionic surfactant may comprise polyethylene sorbitol esters,including polysorbate 80, which is commercially available under thetrademark TWEEN 80® (Sigma Aldrich, St. Louis, Mo.). Polysorbate 80comprises approximately 60%-70% oleic acid with the remainder comprisingprimarily linoleic acids, palmitic acids, and stearic acids. Polysorbate80 may be used in amounts ranging from about 5 to 50%, and in certainembodiments, about 30% of the formulation total mass.

In various other embodiments, the non-ionic surfactant is selected fromone or more of glycerol and polyethylene glycol esters of fatty acids,for example, lauroyl macrogol-32 glycerides and/or lauroyl polyoxyl-32glycerides, commercially available as Gelucire, including, for example,Gelucire 44/11 and Gelucire 44/14. These surfactants may be used atconcentrations greater than about 0.01%, and typically in variousamounts of about 0.01%-10.0%, 10.1%-20%, and 20.1%-30%. In certainexamples, below, Gelucire 44/14 is used as a surfactant in amounts of 1to 10 wt %. See, e.g., Tables 13-17, below. Other non-ionic surfactantsinclude, e.g., Labrasol® PEG-8 Caprylic/Capric Glycerides (Gattefosse)and Labarafil® corn/apricot oil PEG-6 esters (Gattefosse).

In other embodiments, a lubricant is used. Any suitable lubricant may beused, such as for example lecithin. Lecithin may comprise a mixture ofphospholipids.

In additional embodiments, an antioxidant is used. Any suitableanti-oxidant may be used such as, for example and without limitationbutylated hydroxytoluene.

For example, in various embodiments, a pharmaceutical formulationcomprises about 20% to about 80% carrier by weight, about 0.1% to about5% lubricant by weight, and about 0.01% to about 0.1% antioxidant byweight.

The choice of excipient will, to a large extent, depend on factors suchas the particular mode of administration, the effect of the excipient onsolubility and stability, and the nature of the dosage form. Excipientsused in various embodiments may include colorants, flavoring agents,preservatives and taste-masking agents. Colorants, for example, maycomprise about 0.1% to about 2% by weight. Preservatives may comprisemethyl and propyl paraben, for example, in a ratio of about 10:1, and ata proportion of about 0.005% and 0.05% by weight.

As is with all oils, solubilizers, excipients and any other additivesused in the formulations described herein, each is to be non-toxic andpharmaceutically acceptable.

As referenced above, the formulations of the present disclosure aregenerally orally administered, typically via, for example, capsules suchas soft capsules. The present formulations can also be used to formtransdermal patches using standard technology known in the art.Solubilized formulations of the present invention can also be formulatedfor intraperitoneal administration using techniques well known in theart.

In accordance with various embodiments, formulations do not includepeanut oil. The lack of peanut oil obviates the risk posed to thosehaving peanut-based allergies.

Thus, an illustrative embodiment of a pharmaceutical composition of theinvention comprises solubilized estradiol, progesterone at least 75% ofthe progesterone being solubilized (the balance being micronized asdiscussed elsewhere herein), and an oil, wherein the oil is medium chainfatty acid mono- and diesters of glycerol, with or without surfactant.In certain embodiments, a specification for progesterone is set at >80%solubilized, <20% micronized or >85% solubilized, <15% micronized.Specific examples of such illustrative embodiments, with Gelucire assurfactant, in which at least about 85% of the progesterone can besolubilized, include, e.g., the following four formulations:

Qty/Capsule Ingredient(s) Amount (% w/w) (mg) Formulation A- P: 50/EE:0.25: Progesterone, USP, micronized 33.33 50.00 Estradiol Hemihydrate0.17 0.26 Capmul MCM, NF 65.49 98.24 Gelucire 44/14, NF 1.00 1.50 Total100.00 150.00 Formulation B- P: 50/EE: 0.5: Progesterone, USP,micronized 33.33 50.00 Estradiol Hemihydrate 0.35 0.52 Capmul MCM, NF65.32 97.98 Gelucire 44/14, NF 1.00 1.50 Total 100.00 150.00 FormulationC - P: 100/EE: 0.5: Progesterone, USP, micronized 33.33 100.00 EstradiolHemihydrate 0.17 0.52 Capmul MCM, NF 65.49 196.48 Gelucire 44/14, NF1.00 3.00 Total 100.00 300.00 Formulation D - P: 100/EE: 1:Progesterone, USP, micronized 33.33 100.00 Estradiol Hemihydrate 0.341.03 Capmul MCM, NF 65.32 195.97 Gelucire 44/14, NF 1.00 3.00 Total100.00 300.00 Formulation E- P: 200/EE: 2: Progesterone, USP, micronized33.33 200.00 Estradiol Hemihydrate 0.34 2.06 Capmul MCM, NF 65.32 391.94Gelucire 44/14, NF 1.00 6.00 Total 100.00 600.00 *Note: 1.00 mgEstradiol equivalent to 1.03 mg Estradiol Hemihydrate.

In general terms, the above formulations comprise 30 to 35 wt %progesterone, 0.1 to 0.4 wt % estradiol (or estradiol hemihydrate),55 to75 wt % of an oil that is predominantly medium chain fatty acid mono-and diglycerides, such as Capmul MCM, and 0.5 to 10 wt % non-ionicsurfactant, such as Gelucire 44/14. The above formulations may bemodified to comprise excipients, e.g., gelatin such as Gelatin 200Bloom, glycerin, coloring agents such as Opatint red and white, and,optionally, Miglyol 812.

Estradiol solubilization helps ensure high content uniformity andenhanced stability. Fully solubilized progesterone formulations orpartially solubilized progesterone formulations in which at least about50% of the progesterone, e.g., 75%, 80%, 85%, 90%, or >95%, issolubilized appear to provide improved PK-related properties.

According to various embodiments described herein, a 28-day or monthlyregimen of capsules can be packaged in a single kit (e.g., a blisterpack) having administration days identified to improve compliance andreduce associated symptoms, among others. One or more of the capsulesmay contain no estradiol, for example, and/or no progesterone. Capsulesthat comprise no estrogen or progesterone API may be referred to asplacebos. A blister pack can have a plurality of scores or perforationsseparating blister pack into 28 days. Each day may further comprise asingle blister or a plurality of blisters. In various embodiments, eachunit dose may contain micronized and/or partially solubilized, or fullysolubilized progesterone and/or solubilized estradiol in amounts as setforth herein above, although other dose ranges may be contemplated. Inaddition, kits having other configurations are also contemplated herein.For example, without limitation, kits having such blister packs maycontain any number of capsules.

Orally administered formulations of the present disclosure containingmicronized and/or partially solubilized, or fully solubilized,progesterone are also used for the treatment of endometrial hyperplasia,secondary amenorrhea and other disease states treated with supplementalprogesterone. Generally, progesterone-containing formulations describedherein are used to treat the effects of the administration ofsupplemental estrogen whether administered alone or in combination withsolubilized estradiol of the present disclosure or otherestrogen-containing formulations. In various other embodiments, acapsule containing formulations of the present disclosure, for example asoftgel capsule, may be applied in or around the vagina.

Formulations of the present disclosure containing solubilized estradiolare used to treat Estrogen-deficient States, including vasomotorsymptoms, for example, in relation to treatment of hypoestrogenismrelated symptoms including, for example and without limitation, hotflashes and night sweats (vasomotor symptoms), sleep disturbances, moodchanges, vulvo-vaginal atrophy, and osteoporosis and othernon-menopausal disease states treated with supplemental estrogen.

Formulations of the present disclosure containing solubilized estradiolmay be used to treat or prevent atrophic vaginitis or vulvo-vaginalatrophy. In various embodiments, a capsule, for example a softgelcapsule, may be applied in or around the vagina.

Additional objects of the present disclosure includes: providingincreased patient compliance secondary to ease of use; providingincreased physician adoption secondary to ease of use/instruction withless worry of side effects from inappropriate usage; providing decreasedside-effects from erroneous use (decreased irregular bleeding);providing better efficacy/control of symptoms secondary to appropriateuse; reducing the metabolic and vascular side effects of the commonlyused synthetic progestins when administered alone or in combination withan estrogen (norethindrone acetate, medroxyprogesterone acetate, etc.)including, for example, stroke, heart attacks, blood clots and breastcancer.

EXAMPLES Example 1 Estradiol Solubility

In various experiments, suitable solvents were determined for providingsufficient solubility to make 2 mg of estradiol in a 100 mg fill mass,with a desired goal of achieving ˜20 mg/g solubility for estradiol.Initial solubility experiments were done by mixing estradiol withvarious solvents, saturate the solution with the estradiol, equilibratefor at least 3 days and filter the un-dissolved particles and analyzingthe clear supernatant for the amount of estradiol dissolved by HPLC.

Estradiol solubility experiments were performed. From this list at leastone item (e.g. propylene glycol) is known to be unsuitable forencapsulation.

TABLE 1 Ingredient Solubility (mg/g) PEG 400 105*  Propylene Glycol 75*Polysorbate 80 36* Transcutol HP 141  Capmul PG8  31.2 *Literaturereference -Salole, E. G. (1987) The Physicochemical Properties ofOestradiol, J Pharm and Biomed Analysis, 5, 635-640.

In further solubility studies, estradiol was soluble at at least 6 mg/gmMiglyol Transcutol in ratios of 81:19 to 95:5, in Miglyol;ethanol at91:11, and in Miglyol:Capmul PG8 at 88:11, but not in Miglyol:Transcutolat 96:4, Miglyol:Labrasol at 70:30 to 80:20, or Miglyol:Capmul PG8 at86:14.

Example 2

It was desired to achieve 50 mg of progesterone suspended in a mediumthat can also solubilize 2 mg estradiol in a total capsule fill mass of200 mg. In order to achieve this formulation, the required solubility ofestradiol needs to be ˜10 mg/g. A total fill weight of 200 mg wasconsidered suitable for a size 5 oval soft gelatin capsule.

Additional solubility studies were performed to find solvent mixturesthat might possibly be more suitable for soft gelatin encapsulation.Solubility studies were conducted with Capmul PG8 and Capmul MCM bymixing estradiol with various solvent systems and as before by analyzingfor the amount of estradiol dissolved by HPLC after filtration. Resultsof these experiments are presented in Table 2. It can be seen from theseresults that mixtures containing Miglyol:Capmul PG8 at 50%; and alsoCapmul MCM alone or in combination with 20% Polysorbate 80 can achievesufficient solubility to meet the target of 10 mg/g. Capmul PG8 mixedwith Miglyol at the 15 and 30% level did not provide sufficientsolubility.

TABLE 2 Ingredient Solubility (mg/g) Miglyol:Capmul PG8 (85:15) 4.40Miglyol:Capmul PG8 (70:30) 8.60 Transcutol:Miglyol 812:Capmul PG8 >12(5:65:28) Transcutol:Miglyol 812:Capmul PG8 >12 (5:47:47) Miglyol:CapmulPG8 (50:50) 14.0 Capmul MCM 19.8 Polysorbate 80:Capmul MCM (20:80) 15.0

Example 3

Additional studies were performed to assess the stability of estradiol(4-6 mg) in solvent mixtures, as reported in Table 3. Miglyol 812 with4% Transcutol precipitated on Hot/Cold cycling after 96 hours, whileestradiol solubilized in Miglyol:Capmul blends at 30 and 50% or inCapmul MCM alone, did not precipitate under the same conditions for aminimum of 14 days.

TABLE 3 Estradiol Results Hot/Cold Formulation mg/g CyclingTranscutol:Miglyol 812 (4:96) 4 Crystallizes after 96 hours Miglyol812:Capmul PG8 (70:30) 6 Clear, after 14 days Miglyol 812:Capmul PG8(50:50) 6 Clear, after 14 days Transcutol:Miglyol 812:Capmul PG8 6Clear, after 14 days (5:80:15) Capmul MCM 6 Clear after 14 days

12 mg estradiol solubilized in Miglyol:Capmul PG8 50:50, Capmul MCM, andin mixtures of Transcutol: Miglyol: Capmul PG8 are stable and do notprecipitate for at least 12 days.

TABLE 4 Estradiol Results Hot/Cold Formulation mg/g Cycling Miglyol812:Capmul PG8 (50:50) 12 Clear, after 12 days Transcutol:Miglyol812:Capmul PG8 12 Clear, after 12 days (5:65:28) Transcutol:Miglyol812:Capmul PG8 12 Clear, after 12 days (5:47:47) Capmul MCM 12 Clearafter 12 days

Example 4

In addition to determining physical stability of the estradiol solutionsover time, it is necessary to determine if the fill material will bestable during the encapsulation process. One way to test thesepreparations is with the addition of water to the fill mass. As can beseen in Table 5, estradiol solutions at a concentration of 6 mg/g inPolyethylene Glycol 400 and Capmul MCM are able to absorb a minimum of7% water without recrystallization, whereas the same concentration inMiglyol 812:Capmul PG8 (75:25) precipitates.

Estradiol solutions at a concentration of 12 mg/g in Polyethylene Glycol400 and Capmul MCM are able to absorb a minimum of 7% water withoutrecrystallization. All Capmul PG8 containing formulations turned hazy onthe addition of water. However, it should be noted that estradiolrecrystallization was not observed, and the addition of water to CapmulPG 8 alone (without any estradiol) also turns hazy on the addition ofwater.

TABLE 5 Estradiol Results after addition Formulation mg/g of 7% waterMiglyol 812:Capmul PG8 (75:25) 6 Precipitated Miglyol 812:Capmul PG8(50:50) 12 Hazy Transcutol:Miglyol 812:Capmul PG8 12 Hazy (5:65:28)Capmul MCM 12 Clear Transcutol:Miglyol 812:Capmul PG8 12 Hazy (5:47:47)Polyethylene Glycol 400 12 clear

Example 5

In an exemplary embodiment, a capsule is provided containing a fillmaterial comprising:

TABLE 6 Mg/ Ingredient Capsule Estradiol Hemihydrate 2.00 Mono-, di- ortriglyceride (Miglyol 812) qs Diethylene Glycol Monoethylether(Transcutol HP) 65.00 Liquid lecithin 1.63 Butylated Hydroxytoluene 0.13Total Fill Weight 325

Example 6

In an exemplary embodiment, a capsule is provided containing a fillmaterial comprising:

TABLE 7 Mg/ Ingredient Capsule Estradiol Hemihydrate 2.00Monoglycerides/diglycerides/triglycerides of qs caprylic/capric acid(Capmul MCM) Liquid lecithin 1.63 Polysorbate 80 97.5 Total Fill Weight325

In an exemplary embodiment, a capsule is provided containing a fillmaterial comprising:

TABLE 8 Mg/ Amount/ Ingredient Capsule % w/w Batch Estradiol Hemihydrate2.03 0.62 20.2 g Monoglycerides/diglycerides/triglycerides 322.97 99.383.23 kg of caprylic/capric acid (Capmul MCM) Total 100 3.25 kg

The above formulation is prepared as follows: estradiol is added toCapmul MCM and mixed until dissolved.

Example 7 Progesterone Solubility

In various embodiments, both estradiol and progesterone may be dissolvedin a solvent. In various embodiments, the solubility of both estradioland progesterone will be such that a therapeutically effective dose maybe obtained in a reasonably sized mass, generally considered to bebetween 1 mg and 1200 mg, preferably suitable for encapsulation in asize 3 to 22 oval or oblong capsule. For example, in variousembodiments, 50 mg to 100 mg of progesterone may be dissolved in avolume of solvent; i.e., the solubility would be 50 mg to 100 mg percapsule. Miglyol was attempted, and while it can be considered a goodcarrier for progesterone, it alone did not provide a desirable level ofsolubilization of estradiol (e.g., solubility of 12 mg/g may bedesirable in various embodiments). Thus, Miglyol may be used inembodiments comprising a suspension of progesterone, though Miglyol,standing alone, is not desirable for use in embodiments having fullysolubilized progesterone and/or estradiol.

As can be seen in Table 9, the solubility of progesterone in Capmul MCMis ˜73 mg/g. Therefore, by suspending 200 mg progesterone in 400 mg ofsolvent, part of the dose (˜14%) is already dissolved and the remainingis still a suspension. In some aspects and embodiments, it is desired tominimize the partial solubility of progesterone in the formulation inorder to minimize the possibility of recrystalization.

Based on 73 mg/g solubility, the capsule size required to make a capsuleof 50 mg solubilized progesterone would be 685 mg. Therefore, it wasshown that it would be feasible to make a 50 mg progesterone and 2 mgestradiol solubilized formulation. Myglyol had the lowest solubility,but that solvent is unable to dissolve the estradiol, therefore underfurther experiments, it was decided to proceed with the second lowest orCapmul MCM. It has also been found that 2 mg of estradiol may also bedissolved in 685 mg of Capmul MCM.

TABLE 9 Progesterone Solubility Ingredient (mg/g) Capmul MCM 73.4 CapmulPG8 95 Miglyol 812 27.8 Capmul MCM:Gelucire 44/14 (9:1) 86.4 CapmulMCM:Gelucire 44/14 (7:3) 70.5 Capmul MCM:Gelucire 44/14 (6:3) 57.4

In addition, it has been found that the solubility of progesterone in asolvent of Capmul MCM in combination with Gelucire 44/14 in a 9:1 ratioincreases the solubility to approximately 86 mg/g. Therefore, in variousembodiments, progesterone and/or estradiol may be dissolved in a CapmulMCM and Gelucire 44/14 system, wherein the ratio of Capmul MCM toGelucire 44/14 is 9:1.

TABLE 10 Progesterone Solubility Ingredient (mg/g) Capmul MCM:Gelucire44/14 (9:1) 86.4 Capmul MCM:Gelucire 44/14 (7:3) 70.5 CapmulMCM:Gelucire 44/14 (6:4) 57.4

Example 7-1

In an exemplary embodiment, a capsule is provided containing a fillmaterial having fully solubilized progesterone and estradiol comprising:

TABLE 11 Qty/Capsule Ingredient Mass (mg) % w/w (mg) Progesterone, USP,micronized 50.00 7.14 50.00 Estradiol Hemihydrate, USP 2.03 0.29 2.03Capmul MCM, NF 82.57 577.97 Gelucire 44/14, NF 10.0 70.00 TOTAL 100.00700.00

A capsule such as that shown in TABLE 11 may be manufactured in anysuitable manner. For the purposes of this Example, mixing may befacilitated by an impellor, agitator, or other suitable means. Also forthe purposes of this Example, heating and/or mixing may be performedunder an inert or relatively inert gas atmosphere, such as nitrogen gasN2. Mixing and/or heating for the purposes of this Example may beperformed in any suitable vessel, such as a stainless steel vessel.

For example, Campul MCM may be heated to between 30° C. to 50° C., morepreferably from 35° C. to 45° C., and more preferably to 40° C.+/−2° C.Gelucire 44/14 may be added to the Campul MCM and mixed until dissolved.The addition may occur all at once or may occur gradually over a periodof time. Heat may continue to be applied during the mixing of theGelucire 44/14 and the Campul MCM.

Heat may be removed from the Gelucire 44/14 and Campul MCM mixture.Estradiol Hemihydrate may be added to the mixture. The addition mayoccur all at once or may occur gradually over a period of time.Micronized progesterone may then be added to the Gelucire 44/14, CampulMCM and Estradiol Hemihydrate mixture until dissolved. The addition mayoccur all at once or may occur gradually over a period of time.

Example 8

In an exemplary embodiment, a capsule is provided containing a fillmaterial having suspended progesterone comprising:

TABLE 12 mg/ Ingredient Capsule % Function Micronized Progesterone200.00 30.77 Active Medium Chain Triglyceride qs qs Carrier (MIGLYOL 812or equivalent) Lecithin Liquid 1.63 0.25 Lubricant/Emulsifier ButylatedHydroxytoluene 0.13 0.02 Antioxidant (also referred to as “BHT”)

The above formulation is prepared as follows: MIGLYOL is heated to about45° C. GELUCIRE 44/14 is added and mixed until dissolved. BHT is addedand mixed until dissolved. Progesterone is suspended and passed througha colloid mill. The resultant fill mass can be used for encapsulation.

In an exemplary embodiment, a capsule is provided containing a fillmaterial having partially solubilized progesterone comprising:

TABLE 13 Qty/ Qty/ Amount/ Capsule Capsule Batch Ingredient (mg) % w/w(mg) (kg) Micronized Progesterone, 200.00 33.33 Active 2.0 USPMonoglycerides/diglyc- 394.0 65.67 Carrier 3.94 erides/triglycerides ofcaprylic/capric acid (Capmul MCM) Lauroyl polyoxyl-32- 6.0 1 Lubricant/0.06 glycerides (Gelucire 44/14 Emulsifier or equivalent) Total 600.00mg 100 6.0 kg

For suspensions of progesterone and partially solubilized progesterone,GELUCIRE 44/14 may be added at 1% to 2% w/w to increase viscosity. Theabove formulation is prepared as follows: Capmul MCM is heated to about65° C. GELUCIRE 44/14 is added and mixed until dissolved. Heat isremoved. Progesterone is added and the mixture is passed through acolloid mill. The resultant fill mass can be used for encapsulation.

Example 9

In an exemplary embodiment, a capsule is provided containing a fillmaterial having suspended progesterone comprising:

TABLE 14 mg/ Ingredient % Capsule Function Micronized Progesterone 30.77200.00 Active Medium Chain Triglyceride 65.93 428.55 Carrier (MIGLYOL812 or equivalent) Lauroyl polyoxyl-32-glycerides 3.00 19.50 SuspendingAgent (Gelucire 44/14 or equivalent) Butylated Hydroxytoluene 0.03 1.95Antioxidant Total 100 650

In various embodiments, amounts of MIGLYOL may be present in a rangefrom about 35-95% by weight; GELUCIRE 44/14 from about 0.5-30% byweight; and BHT from about 0.01-0.1% by weight.

Example 10

For the purposes of this Example, a particle size analysis is conductedby using the Beckman Device. A sample API comprising micronizedprogesterone in accordance with various embodiments is provided foranalysis.

Approximately 0.01 g of a sample API in accordance with variousembodiments was combined with Coulter 1B and 10 mL of deionized water.Sonication was performed for 15 seconds. The Beckman Device, equippedwith a ULM, performed analysis for 90 seconds. The Beckman Device wasconfigured to use the Fraunhofer optical model. The Beckman Deviceyielded that the sample has an X50 of 4.279 μm, an X75 of 7.442 μm, andan X25 of 1.590 μm. The Beckman Device also yielded that the meanparticle size is 4.975 μm, the median particle size is 4.279 μm, themode particle size is 6.453 μm, and the standard deviation is 3.956 μm.A graph of the particle distribution obtained is shown in FIG. 4.

Example 11

A formulation sample having approximately 200 mg of micronizedprogesterone and 2 mg of estradiol was dispersed with oil. The BeckmanDevice, equipped with a MLM, performed analysis for 60 seconds. TheBeckman Device was configured to use the Fraunhofer optical model. TheBeckman Device yielded that the sample has an X50 of 11.0 μm, an X75 of17.3 μm, and an X25 of 5.3 μm. The Beckman Device also yielded that themean particle size is 11.8 μm, the median particle size is 11.04 μm, themode particle size is 13.6 μm, and the standard deviation is 7.8 μm.

Example 12

In order to increase the solubility of progesterone in the finalsolution, Gelucire 44/14 was added at about 10% w/w.

TABLE 15 Quantitative Formula: Batch Size 10,000 capsules Label Qty/Amount/ Item Claim Capsule Batch No. Ingredient(s) (mg) % w/w (mg)(kg) 1. Progesterone, USP, 50.00 7.14 50.00 0.50 micronized 2. EstradiolHemihydrate, 2.03 0.29 2.03 0.02 USP 3. Capmul MCM, NF 82.57 577.97 5.784. Gelucire 44/14, NF 10.0 70.00 0.70 Total: 100.00 700.00 7.00

An example of the final formulation is provided in Table 15. Themanufacturing process is as follows. Capmul MCM is heated to 40° C.Gelucire 44/14 is heated to 65 C and added and mixed until dissolved.Heat is removed. Estradiol is added and mixed until dissolved.Micronized progesterone is then added and mixed until dissolved.

Example 13

In an exemplary embodiment, a capsule is provided containing a fillmaterial having fully solubilized estradiol and partially solubilizedprogesterone comprising:

TABLE 16 Label Qty/ Amount/ Item Claim Capsule Batch No. Ingredient(s)(mg) % w/w (mg) (g) 1. Progesterone, USP, 50.00 25.000 50.00 500.00micronized 2. Estradiol Hemihydrate 0.25 0.129 0.26 2.58 3. Capmul MCM,NF 73.371 146.74 1467.42 4. Gelucire 44/14, NF 1.500 3.00 30.00 Total:100.000 200.00 mg 2000.00

The manufacturing process is as follows. Capmul MCM is heated to 65° C.Gelucire 44/14 is added and mixed until dissolved. Heat is removed.Estradiol is added and mixed until dissolved. Micronized progesterone isthen added and dispersed. The mixture is then passed through a colloidmill. The resultant fill mass can be used for encapsulation.

Example 14

In an exemplary embodiment, a capsule is provided containing a fillmaterial having fully solubilized estradiol and partially solubilizedprogesterone comprising:

TABLE 17 Label Qty/ Amount/ Item Claim Capsule Batch No. Ingredient(s)(mg) % w/w (mg) (g) 1. Progesterone, USP, 200.00 33.33 200.0 2000.0micronized 2. Estradiol Hemihydrate 2.00 0.35 2.07 20.7 3. Capmul MCM,NF 65.32 391.93 3919.3 4. Gelucire 44/14, NF 1.00 6.0 60.0 Total: 100.00600.0 mg 6000.0

The manufacturing process is as follows. Capmul MCM is heated to 65° C.Gelucire 44/14 is added and mixed until dissolved. Heat is removed.Estradiol is added and mixed until dissolved. Micronized progesterone isthen added and dispersed. The mixture is then passed through a colloidmill. The resultant fill mass can be used for encapsulation.Alternatively, Gelucire 44/14 is heated to 65 C and Capmul MCM is heatedto 40 C+/−5 C to achieve mixing of the oil and the surfactant beforeheat is removed; estradiol is added while the mixture is cooling;progesterone is added when the mixture has dropped below about 40 C; themixture is then passed through a colloid mill, e.g., three times.

Example 15

Study 352—Progesterone and Estradiol Combination Study under FedConditions.

This following study protocol was used to establish bio-availability andbio-equivalence parameters for a combination product of the presentdisclosure comprising progesterone (200 mg) and estradiol (2.0 mg) asprepared via the process described in Example 14 and compared to 200 mgof PROMETRIUM® (Catalent Pharmaceuticals, St. Petersburg, Fla. (and 2.0mg of ESTRACE® (Bristol-Myers Squibb Co. Princeton, N.J.), administeredto twenty-four (24) normal healthy, adult human post-menopausal femalesubjects under fed conditions.

The pharmaceutical formulation of the invention used in these PK studieshad substantially the following formula:

Qty/Capsule Ingredient(s) Amount (% w/w) (mg) Progesterone, USP,micronized 7.14 50.00 Estradiol Hemihydrate, USP Micronized 0.30 2.07Capmul MCM, NF, USP 83.27 582.93 Gelucire 44/14, NF 9.29 650 Total100.00 700

The Study Design: An open-label, balanced, randomized, two-treatment,two-period, two-sequence, single-dose, two-way crossover study.

The subjects were housed in the clinical facility from at least 11.00hours pre-dose to at least 48.00 hours post-dose in each period, with awashout period of at least 14 days between the successive dosing days.

Subjects were fasted for at least about 10.00 hours before being serveda high-fat, high-calorie breakfast, followed by dosing, then followed bya 04.00 hour, post-dose additional period of fasting.

Standard meals were provided at about 04.00, 09.00, 13.00, 25.00, 29.00,34.00 and 38.00 hours post-dose, respectively.

Water was restricted at least about 01 hour prior to dosing until about01 hour post-dose (except for water given during dosing). At othertimes, drinking water was provided ad libitum.

Subjects were instructed to abstain from consuming caffeine and/orxanthine containing products (i.e. coffee, tea, chocolate, andcaffeine-containing sodas, colas, etc.) for at least about 24.00 hoursprior to dosing and throughout the study, grapefruit and\or its juiceand poppy containing foods for at least about 48.00 hours prior todosing and throughout the study.

Subjects remained seated upright for about the first 04.00 hourspost-dose and only necessary movements were allowed during this period.Thereafter subjects were allowed to ambulate freely during the remainingpart of the study. Subjects were not allowed to lie down (except asdirected by the physician secondary to adverse events) duringrestriction period.

Subjects were instructed not to take any prescription medications within14 days prior to study check in and throughout the study. Subjects wereinstructed not to take any over the counter medicinal products, herbalmedications, etc. within 7 days prior to study check-in and throughoutthe study.

After overnight fasting of at least about 10.00 hours, a high-fathigh-calorie breakfast was served about 30 minutes prior toadministration of investigational product(s). All subjects were requiredto consume their entire breakfast within about 30 minutes of it beingserved, a single dose of either test product (T) of Progesterone 200 mg& Estradiol 2 mg tablets or the reference product (R) PROMETRIUM®(Progesterone) soft gel Capsule 200 mg and ESTRACE® (Estradiol) Tablets2 mg (according to the randomization schedule) were administered withabout 240 mL of water under fed condition, at ambient temperature ineach period in sitting posture. A thorough mouth check was done toassess the compliance to dosing.

All dosed study subjects were assessed for laboratory tests at the endof the study or as applicable.

In each period, twenty-three (23) blood samples were collected. Thepre-dose (10 mL) blood samples at −01.00, −00.50, 00.00 hours and thepost-dose blood samples (08 mL each) were collected at 00.25, 00.50,00.67, 00.83, 01.00, 01.33, 01.67, 02.00, 02.50, 03.00, 04.00, 05.00,06.00, 07.00, 08.00, 10.00, 12.00, 18.00, 24.00 and 48.00 hours inlabeled K2EDTA—vacutainers via an indwelling cannula placed in one ofthe forearm veins of the subjects. Each intravenous indwelling cannulawas kept in situ as long as possible by injecting about 0.5 mL of 10IU/mL of heparin in normal saline solution to maintain the cannula forcollection of the post-dose samples. In such cases blood samples werecollected after discarding the first 0.5 mL of heparin containing blood.Each cannula was removed after the 24.00 hour sample was drawn orearlier or if blocked.

At the end of the study, the samples were transferred to thebio-analytical facility in a box containing sufficient dry ice tomaintain the integrity of the samples. These samples were stored at atemperature of −70° C.±20° C. in the bio-analytical facility untilanalysis.

Progesterone (Corrected and Uncorrected) and Estradiol (unconjugated)and estrone (total) in plasma samples is assayed using a validatedLC-MS/MS method.

The pharmacokinetic parameters Cmax, AUC0-t & AUC0-∞ were calculated ondata obtained from 24 subjects for the test product and referenceproduct. In general, bioavailability of progesterone and estradiol weresimilar but bioequivalence was not established.

Corrected pharmacokinetic profile summaries are presented in Table 18,below, for progesterone.

TABLE 18 Summary of Primary Pharmacokinetic Profile of Test Product (T)versus Reference Product (R) for Progesterone (Corrected) ArithmeticMean ± Standard Geometric Mean* Deviation Test Reference Test ReferencePharmacokinetic Product Product Product Product Parameter (T) (R) (T)(R) C_(max) 47.0 43.0 81.0 ± 82.8 117.7 ± 173.7 AUC_(0-t) 107.6 97.8163.9 ± 136.5 191.1 ± 241.7 AUC_(0-∞) 110.7 110.0 173.5 ± 143.0 207.1 ±250.3 *Estimate of Least Square Mean used to calculate Geometric Mean

Study 351—Progesterone and Estradiol Combination Study under FastingConditions.

Fasted studies using the above protocol and test and reference productswere also conducted. However, rather than the high-fat meal prior toadministration of the test and reference drug, each subject fasted for aperiod of at least twelve (12) hours prior to dose administration.

The pharmacokinetic parameters Cmax, AUC0-t & AUC0-∞ were calculated ondata obtained from 23 subjects under fasting conditions for the testproduct and reference product. In general, bioavailability ofprogesterone and estradiol were similar but bioequivalence was notestablished.

Corrected pharmacokinetic profile summaries are presented in Table 19,below for progesterone.

TABLE 19 Summary of Primary Pharmacokinetic Profile of Test Product (T)versus Reference Product (R) for Progesterone (Corrected) ArithmeticMean ± Standard Geometric Mean* Deviation Test Reference Test ReferencePharmacokinetic Product Product Product Product Parameter (T) (R) (T)(R) C_(max) 2.3 3.0  2.9 ± 2.3 3.9 ± 3.4 AUC_(0-t) 8.4 10.9 11.2 ± 8.714.5 ± 11.0 AUC_(0-∞) 12.9 17.2 15.1 ± 9.0 19.6 ± 10.2 *Estimate ofLeast Square Mean used to calculate Geometric Mean

The data indicate good (i.e., low) inter-patient and intra-patientvariability relative to Prometrium.

Example 16

Method of manufacture in accordance with various embodiments are shownin FIGS. 1-3. With reference to FIG. 1, method of fill material 100 isshown. Step 102 comprises heating an oily vehicle carrier to 40° C.±5°C. Heating may be accomplished through any suitable means. The heatingmay be performed in any suitable vessel, such as a stainless steelvessel. The oily vehicle may be any oily vehicle described herein, forexample, Capmul MCM.

Step 104 comprises mixing Gelucire 44/14 with the oily vehicle. Mixingmay be facilitated by an impellor, agitator, or other suitable means.Step 102 may be performed under an inert or relatively inert gasatmosphere, such as nitrogen gas N2. Mixing may be performed in anysuitable vessel, such as a stainless steel vessel.

Step 106 comprises mixing estradiol into the mixture of the oily vehicleand Gelucire 44/14. Mixing may occur in a steel tank or vat. Mixing maybe facilitated by an impellor, agitator, or other suitable means. Step106 may be performed under an inert or relatively inert gas atmosphere,such as nitrogen gas N2.

Step 108 comprises cooling to room temperature. Cooling may be allowedto occur without intervention or cooling may be aided by application ofa cooling system.

Step 110 comprises mixing micronized progesterone into the mixture ofoily vehicle, estradiol and Gelucire 44/14. Mixing may occur in a steeltank or vat. Mixing may be facilitated by an impellor, agitator, orother suitable means. Step 110 may be performed under an inert orrelatively inert gas atmosphere, such as nitrogen gas N2. Step 112comprises degasing. The resulting mixture from step 112 may comprise afill material suitable for production into a softgel capsule.

With reference to FIG. 2, softgel capsule, i.e. gel mass, production 200is shown. Step 202 comprises mixing glyercin with water. The water usedin step 202 may be purified by any suitable means, such as reverseosmosis, ozonation, filtration (e.g., through a carbon column) or thelike. Mixing may be facilitated by an impellor, agitator, or othersuitable means. Step 202 may be performed under an inert or relativelyinert gas atmosphere, such as nitrogen gas N2. Heating may be performeduntil the temperature reaches 80° C.±5° C.

Step 204 comprises the addition of gelatin to the glycerin watermixture. Mixing may be facilitated by an impellor, agitator, or othersuitable means. Step 204 may be performed under an inert or relativelyinert gas atmosphere, such as nitrogen gas N2. A vacuum may be drawn instep 204 to de-aerate.

Step 206 comprises addition of a coloring agent such as a dye. Acoloring agent may comprise products sold under the trademark OPATINT orother suitable agent. Step 206 may be performed under an inert orrelatively inert gas atmosphere, such as nitrogen gas N2. Step 208comprises degasing. The resulting mixture from step 208 may comprise agel capsule material suitable for use as a gel capsule in production ofa softgel capsule.

With reference to FIG. 3, softgel capsule assembly process 300 is shown.Step 302 comprises heating the fill material. The fill material may beheated to any suitable temperature. In various embodiments, the fillmaterial is heated to 30° C.+/−3° C. Fill material maybe heated in afill hopper. A fill hopper may comprise a device configured to hold avolume of the fill material and/or to dispense the fill material incontrolled volumes.

Step 304 comprises filling a gel mass. A gel mass may be taken from thegel capsule material produced in step 208 of FIG. 2. Filling may beperformed by injecting, placing, or otherwise disposing the fillmaterial within a volume defined by the gel capsule material. Thefilling may occur in an encapsulator. The spreader boxes may be atemperature of 55° C.+/−10° C. The wedge temperature may be 38° C.+/−3°C. The drum cooling temperature may be 4° C.+/−2° C. The encapsulatormay be lubricated using MIGLYOL 812 or other suitable lubricant. Step304 thus produces one or more softgel capsules. Filling may compriseproducing a ribbon of thickness 0.85 mm±0.05 mm using spreader boxknobs. The fill material may be injected into the gel to produce a fillweight having target weight±5% (i.e., 650±33 mg and 325±16.3 mg).

Step 306 comprises drying the softgel capsules. Drying may be performedin a tumble dryer, tray dryer, or combinations thereof. For example,drying may be performed in a tumble drying basket for between about 10minutes and about 120 minutes. Drying may continue in a drying room forabout 24 hours to about 72 hours. Step 308 may comprise inspectionand/or polishing. Polishing may be performed with isopropyl alcohol.Step 310 may comprise packaging. Packaging may be accomplished throughany suitable means. Packaging may comprise packing softgel capsules intoa blister pack, bottle, box, pouch, or other acceptable packaging.

Example 17 Solubility of Estradiol in Soy Bean Oil, Peanut Oil, andSafflower Oil

Data was obtained visually by making the mixtures described below,sonicating the mixtures, and then seeing if a clear solution resulted.If a clear solution was achieved, it was an indication of solubility atthe level studied.

Procedures and Results:

Step 1.

0.3% of Estradiol suspension in each oil was prepared by adding 30 mgEstradiol to solvent and QS to 10 g. Samples were mixed on vortex for 2hours, heated @ 50° C. for 30 minutes and then mixed for 1 hour more.All samples were still in suspension form.

Step 2.

Each sample was diluted to 0.24% (by adding 2.5 g more oil) and mixedfor 2 hours and heated @ 50° C. for 30 min and mixed again for one hour.All the samples were still cloudy. Samples were kept at room temperatureovernight to see if they precipitate or if un-dissolved API settles out.After 20 hours at room temperature, it was observed that all samplesstill had un-dissolved API.

Step 3.

Each sample was diluted to 0.2% (by adding 2.5 g more oil) and mixed 2for hours and heated @ 50° C. for 30 min and mixed again for one hour.All the samples were still slightly cloudy, indicating that theestradiol was not completely dissolved.

TABLE 20 Estradiol Solubility Estradiol Solubility Ingredient (mg/g) (%w/w) Peanut Oil <2 <0.2 Safflower Oil <2 <0.2 Soy Bean Oil <2 <0.2

The solubility of estradiol in all three oils was less than 2 mg/g (0.2%w/w). This level of solubility is significantly below the solubilitythat the present inventors have discovered can be achieved in otheroils, e.g., medium chain fatty acid esters, such as themono/diglycerides, propylene glycol esters, and polyethylene glycolesters discussed above.

In sum, if no heat is used to dissolve estradiol in safflower oil, itwill not go into solution. Given that the estradiol did not dissolve at50 C, oils such as safflower oil will not be useful in the methods ofthe invention using medium chain fatty acid esters as describedhereinabove.

Example 18 Dissolution

Dissolution studies were performed using a formulation of this inventioncomparing the dissolution of progesterone to the dissolution ofPrometrium and comparing the dissolution of estradiol to the dissolutionof Estrace. In one study, a formulation of the invention in capsulescomprising 200 mg of progesterone and 2 mg estradiol was used. In asecond study, a formulation of the invention in capsules comprising 50mg of progesterone and 2 mg estradiol was used. The two formulationscomprised:

The dissolution study was performed using a USP dissolution apparatus(reciprocating cylinder) (“USP Apparatus 3”). The apparatus was set to30 dips per minute. 250 mL of a solution of 0.1N HCl with 3% sodiumlauryl sulfate was used at 37 C.

In both studies, progesterone was dissolved faster, and with smallerstandard deviations, from the capsules of the invention than fromPrometrium. Dissolution of estradiol was comparable but marginallyslower from the capsules of the invention than from Estrace. Forillustrative purposes, a graph showing progestrone dissolution from the200 mg progesterone capsule of the invention and from Prometrium isattached as FIG. 5.

Both capsules of the invention were stable on storage in white HDPEbottles. Positive stability data were obtained with the 200 mgprogesterone formulation over 6 months (>6 months data unavailable) andwith the 50 mg progesterone formulation over 3 months (>3 months dataunavailable).

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the present disclosurewithout departing from the spirit or scope of the disclosure. Thus, itis intended that the present disclosure cover the modifications andvariations of this disclosure provided they come within the scope of theappended claims and their equivalents.

Likewise, numerous characteristics and advantages have been set forth inthe preceding description, including various alternatives together withdetails of the structure and function of the devices and/or methods.This disclosure is intended as illustrative only and as such is notintended to be exhaustive. It will be evident to those skilled in theart that various modifications may be made, especially in matters ofstructure, materials, elements, components, shape, size and arrangementof parts including combinations within the principles of the disclosure,to the full extent indicated by the broad general meaning of the termsin which the appended claims are expressed. To the extent that thesevarious modifications do not depart from the spirit and scope of theappended claims, they are intended to be encompassed therein.

We claim:
 1. A pharmaceutical composition comprising: a solubilizingagent, the solubilizing agent comprising an effective amount of a C6-C12oil; 0.5 mg estradiol or 0.52 mg estradiol hemihydrate, the estradiol orestradiol hemihydrate being at least about 90% solubilized in thesolubilizing agent; and 100 mg progesterone; wherein a portion of theprogesterone is suspended; and wherein the estradiol or the estradiolhemihydrate and the suspended progesterone are uniformly dispersed. 2.The pharmaceutical composition of claim 1, wherein the solubilizingagent is selected from at least one of monoglycerides, diglycerides,triglycerides, and combinations thereof, wherein the monoglycerides,diglycerides, and triglycerides are predominantly of C6-C12 fatty acidchain lengths.
 3. The pharmaceutical composition of claim 2, wherein themonoglycerides, diglycerides, and triglycerides are >50% C6-C12 fattyacid chain lengths.
 4. A pharmaceutical composition comprising: about100 mg progesterone; about 0.5 mg estradiol or about 0.52 mg estradiolhemihydrate, the estradiol or estradiol hemihydrate being at least about90% solubilized; about 196.48 mg of monoglycerides and diglycerides ofcaprylic acid and capric acid (CAPMUL MCM); and about 3.0 mg of at leastone of lauroyl macrogol-32 glycerides EP, lauroyl polyoxyl-32 glyceridesNF, or lauroyl polyoxylglycerides (GELUCIRE 44/14); wherein a portion ofthe progesterone is suspended; and wherein the estradiol or theestradiol hemihydrate and the suspended progesterone are uniformlydispersed.
 5. A method comprising administering an effective amount ofpharmaceutical composition to a subject in need thereof, thepharmaceutical composition comprising: about 100 mg progesterone; about0.5 mg estradiol, the estradiol being at least about 90% solubilized inthe solubilizing agent; about 196.48 mg of monoglycerides anddiglycerides of caprylic acid and capric acid (CAPMUL MCM); and about3.0 mg of at least one of lauroyl macrogol-32 glycerides EP, lauroylpolyoxyl-32 glycerides NF, or lauroyl polyoxylglycerides (GELUCIRE44/14); wherein a portion of the progesterone is suspended; and whereinthe estradiol and the suspended progesterone are uniformly dispersed. 6.The method of claim 5, wherein the pharmaceutical composition isadministered as a continuous-combined therapy regimen.
 7. The method ofclaim 5, wherein the pharmaceutical composition is administered asequentially-combined therapy regimen.
 8. A method comprisingadministering an effective amount of a pharmaceutical compositioncomprising: 0.5 mg estradiol or about 0.52 mg estradiol hemihydrate, theestradiol or estradiol hemihydrate being about 90% solubilized, theestradiol being at least about 90% solubilized in the solubilizingagent; 100 mg progesterone; and 7 a solubilizing agent, the solubilizingagent comprising an effective amount of a C6-C12 oil; wherein a portionof the progesterone is suspended; wherein the estradiol and thesuspended progesterone are uniformly dispersed; and wherein thepharmaceutical composition is administered once daily for the treatmentof symptoms associated with menopause.
 9. The method of claim 8, whereinthe pharmaceutical composition is administered as a continuous-combinedtherapy regimen.
 10. The method of claim 8, wherein the pharmaceuticalcomposition is administered as a sequentially-combined therapy regimen.11. The method of claim 8, wherein the solubilizing agent is selectedfrom at least one of monoglycerides, diglycerides, triglycerides, andcombinations thereof, wherein the monoglycerides, diglycerides, andtriglycerides are predominantly of C6-C12 fatty acid chain lengths. 12.The method of claim 11, wherein the monoglycerides, diglycerides, andtriglycerides are >50% C6-C12 fatty acid chain lengths.